Man in the Mirror
by ggo85
Summary: A situation with James forces Martin to confront his past.
1. Chapter 1

**Setting: This story is another in my series of JH vignettes. There are NO SPOILERS for S8.**

 **As always, thanks to my terrific beta JD517. She helps me with the inner workings of the minds 10-year-old boys, reminds me of the importance of "British-isms" in a story set in the UK, and provides numerous other helpful suggestions. If anything remains amiss, it's my fault entirely.**

 **The story and characters of Doc Martin belong to Buffalo Pictures. This story is for amusement only and no infringement of any legal rights is intended.**

* * *

It was _the_ party, the talk of our Year 6 class. Trevor Frakes would turn eleven in two weeks and he was having a birthday party. Not just any party, mind you, but a _paintball_ party. Over the years, I'd gone to lots of birthday parties with swimming and museums (boring!) and bowling and go-karts and camping. Last year for my tenth birthday, we'd had a magician – had to admit that was pretty cool. Still, no one in my class had EVER done paintball. It was too awesome even to think about.

It would be boys only, of course, and Trevor made sure every boy in our class knew what he was planning. He made sure we knew that only some of us in the class – his "mates" – would be invited.

When I had my birthday parties, Mum made me invite every boy in the class – and sometimes the girls too. "We don't want to leave anyone out, now do we," she'd say. "How would you feel if you weren't invited to the party?"

At the time, I hadn't given it much thought. Now I kind of knew what she'd meant because I certainly didn't want to be the one left out of this party – not being able to go or, even worse, hearing everyone talk about the party at school on the Monday after knowing I hadn't been there would be worse than terrible.

It wasn't a done deal that I'd be invited. cTrevor and I had been in school together since Year 1 and got on alright, but he and I weren't what you'd call best mates. It seemed that everyone in the class was now trying to be his best friend, saying or doing all sorts of nice things in the hopes of being invited to the party. I'd yet to do anything special.

"It's kind of stupid," I said to my mum across the table at supper. Dad was out on a home visit and wasn't sure when he'd be back, so we'd started without him.

Mum had made cottage pie with potatoes, one of my favorites. Dad liked fish and vegetables and, on nights like this when she cooked something he didn't like, she'd also cook fish just for him.

"What's stupid?" Mum asked.

"Everyone being extra nice to Trevor just to be invited to his birthday party," I said, stuffing a huge piece of meatloaf into my mouth. "Can you believe Kieran carried his books home from school and Graham brought him biscuits!"

Mum gave me one of her looks. "James, please don't talk with your mouth full."

"Yes, Mum." I dutifully swallowed my food before I started talking again. "Anyway, they're doing all this stuff just so he'll like them and invite them to his party."

"What's so special about _this_ party?"

I took a deep breath and held it. "He's having a . . . paintball party," I said. "It's the coolest party anyone's had in . . . like forever," I added, watching as Mum frowned at my use of the word "like."

"Sounds very exciting."

"So, do you think it will work – doing stuff to make him like you?"

"I'm certain Trevor knows who his friends are."

"Well, I hope I'm one of his friends, since it's the best party of the whole year."

"Isn't he inviting everyone in the Year 6 class?"

"Nope." I stabbed at my potatoes. "Just his 'friends.'"

We both turned at the sound of Dad unlatching the door.

"That seems a little unfair," Mum said.

Dad set down his medical case and gave Mum a peck on the cheek. "Evening, James," he said to me.

"Hi, Dad."

Dad looked at our plates and frowned.

"Fish is in the oven, Martin," Mum said, and I sometimes wondered if she could read Dad's mind.

Dad busied himself preparing his own dinner. "What seems unfair?" he asked, pulling the fish from the oven.

"What?" Mum asked.

"When I came in. You were saying something was unfair."

"Oh that. One of James' schoolmates is having a party and apparently is only inviting some of the children in the class."

"What's wrong with that? It's his party; he can invite anyone he likes."

"I know that, Martin. But inviting some children and not inviting others means that some will be left out. Being excluded can create self-esteem problems, especially in children."

"As a child, I frequently was not invited to parties. My self-esteem, as you put it, didn't suffer.

"What's self-esteem?" I asked.

"It's how you view yourself," Dad explained. Your sense of confidence and self-worth." He washed and dried his hands before sitting down at the table next to me. He placed his napkin on his lap and began to eat.

"Exclusion can be very hurtful and stressful, Martin."

"It's a birthday party, Louisa. It's not like he's being excluded from university."

Excluded – that meant left out. Had I been left out? From Trevor's party. Did Dad know something I didn't? Did one of his patients tell him that I hadn't been invited?

"Martin, as a teacher, I can't tell you how many behavioral problems originate when a child is left out of an activity by his peers."

"Dad . . ."

Dad was still talking to Mum. "I don't doubt that. On the other hand, one's self-esteem shouldn't be contingent on the views or actions of another person – especially if that person happens to be a ten-year-old child."

"Dad!"

"What is it, James?"

"Are you saying I'm not invited to Trevor's party?"

"Who's Trevor?"

Mum shook her head. "Oh, Martin!" She took a deep breath. "Trevor is James' friend who's having the birthday party for a select group of boys." She turned to me. "Your father was talking generally – he was not saying that you hadn't been invited to Trevor's party. Isn't that right, Martin?"

"Um. Yes."

"Now, James, you need to finish your supper and start on your homework. And we," she added, giving Dad one of _those_ looks, "can finish our discussion later."

* * *

A few days later, Trevor called to invite me to his party. I'd squealed with delight, running excitedly through the house.

"I got invited!" I couldn't help myself from shouting. "I got invited to the party!"

"James!" Dad gave me a stern look as I ran into the kitchen. "Don't shout in the house."

"Sorry, Dad. But I can't help it. I got invited to the party." I was almost jumping up and down, I was so excited.

"Trevor's paintball party?" Mum asked, looking up from the kitchen table where she was marking papers.

"Yes!" I said, unable to stop grinning. "Can you believe it?"

"When is the party?" Mum asked.

"Next Saturday."

Dad turned to me. "James, give me a hand putting away the dishes, please."

I dutifully walked over to the dishwasher and started unloading plates and cups and bowls. Much as I hated kitchen chores, at the moment I'd do anything to stay in my parents' good graces so they'd allow me to go to the party. I was pretty sure Mum would agree. I wasn't so sure about Dad. Dad wasn't too keen on things that weren't "educational," and I didn't think I could convince him that paintball would improve my mind. Then again, he was a fan of fresh air and exercise and paintball would definitely have both of those.

"What's a paintball party?" Dad asked.

I wasn't completely surprised my dad didn't know about such things; he wasn't exactly up on what was popular with my friends – unless it was something that caused them to end up in his surgery. I knew that the key to getting him to agree to let me go to the party was explaining it without making it sound dangerous.

"It's a party for Trevor's birthday."

"Trevor's his friend in his class at school," Mum reminded him.

"He's having his party at a paintball place. We get to—" I didn't want to say "shoot" as that definitely wouldn't go over well with Dad. Over the years, he'd dealt with more than his fair share of people accidentally shooting themselves or someone else. Also, if he thought violence was involved . . . it was a non-starter. "It's sort of like hide and seek only when you're found, the person squirts you with paint."

"With what?" Dad asked.

"Paint."

"I meant what do they use to shoot the paint?"

I struggled with how to answer his question without using the word gun and quickly gave up. "They're paint guns," I almost whispered. "Kind of like water guns only with paint."

Uh-oh. My father's expression was somewhere between confused and horrified.

"It's fine, Martin," Mum quickly reassured him. "Paintball is very popular with boys his age."

Dad was now frowning, which set off warning bells in my head. "It sounds dangerous," he said. "If James were to get shot in the eye . . . "

Before I could answer, Mum jumped in again. "They wear protective gear, Martin. "And they have special games designed for children his age."

I decided this wasn't the time to remind them that I was no longer a child. Best to keep quiet and let Mum fight my battle for me.

Dad still didn't look convinced. "The last thing I need is a group of boys in my surgery with all manner of injury—"

"Martin, they wouldn't let children participate if it weren't safe."

" _They_ let children do many things that aren't safe. Do I need to tell you about the injuries I see from falling off scooters or trampolines or—"

"Dad! Every boy in my class wants to go to this party. Heck, everyone in the school wants to go." I didn't care that I was begging. "If I don't go, I'll be . . . I just have to go."

"James," Mum said. "Why don't you finish up your homework and get ready for bed. I'll talk about this with your father." She said the last with a smile and even a tiny wink that told me she'd be on my side. I sure hoped so. I didn't know what I'd do if they didn't let me go. I'd be the laughingstock of the whole school. I'd never again be invited to anything. I'd have no friends. My whole year would be ruined!

I climbed halfway up the stairs and sat down, wanting to hear what my Mum and Dad were saying. Mum just had to convince Dad to let me go – she just had to!

"I don't understand the need for such extravagant parties for children," Dad was saying. "What's wrong with a simple party with cake and ice cream?"

"I can't believe you're actually in favor of cake and ice cream."

Even from where I sat, I could hear Dad snort. "I'm not. I don't understand why people insist on celebrating another year of life by eating high sugar, high-calorie, carbohydrate-laden foods that clog the arteries and increase weight gain, thereby actually shortening life."

"No, Martin, I'm sure you don't."

There was silence for a few minutes and I started to head the rest of the way up the stairs, when Dad's voice stopped me.

"Louisa, this paintball idea is dangerous. Look at this." I wondered if he was showing Mum something on his computer. "It says here: 'Depending on the distance from where the shot was fired, a direct paintball impact commonly causes bruises. In certain areas and at close range, these impacts may leave welts, or even break the skin and cause bleeding.' I can't believe you would even think of allowing our son to participate in something like this."

Oh boy. Mum's got her work cut out for her now.

"Martin, I talked with Mrs. Frakes."

"Who?"

Mum sighed. "Trevor's mum. The company doing the party specializes in paintball for children. The kids must wear face masks. And, they use low-impact, fragile paintballs that they promise won't do any damage."

"They promise do they? The very people who are profiting from this. Now that's reassuring."

"I've researched it too, Martin, and talked to a couple of mums in Wadebridge whose kids have done it. They say it's mostly running around dressed like G.I. Joe. And the articles I've read say that paintball is one of the safest sports."

"I don't understand why it's so important for James to attend this party."

"Paintball is very exciting for boys this age."

"It doesn't sound exciting to me."

"Well, you're not ten."

Dad merely grunted.

"As to why he's so keen on going . . . children want to fit in, to be part of the group. All of James' friends will be going. How would he explain why he can't go?"

"Louisa, we don't need to justify our actions to the moronic parents of this village – or to their children."

"We wouldn't, but James would. He'd be devastated."

That's true, I silently agreed.

"Martin, he just wants to go to a party with his friends. He's my son too and if I thought for a moment he could be hurt, I'd never let him go."

Much as I wanted to keep listening, I knew I'd better get my homework done. Not being prepared for class tomorrow was a sure way to have both Mum and Dad take away privileges, probably starting with Trevor's party. I stood up and climbed the remaining stairs to my room, hoping against hope that Mum would win out.


	2. Chapter 2

Somehow, Mum had managed to convince Dad to let me go to Trevor's party. I don't know what she'd said or did and I definitely wasn't going to ask.

It was kind of funny. I'd found over the years that Dad usually got his way with things between them – except when it came to me. When my parents had to decide stuff about me – where I'd go to school, what I'd be allowed to do, even stupid stuff like how short to cut my hair – Mum usually won out. Maybe it was because of her being a schoolteacher or maybe something else. The only exception was if whatever they were deciding involved my health – that's when Dad would put his foot down and nothing would change his mind. For now, I was just happy that Mum had won out this time.

The paintball party was all anyone had talked about at school the day before – heck, the week before - and our teacher, Mrs. Smithers, was at her wit's end trying to get us to pay attention to anything she was saying. We were much more interested in who was going and what types of games we'd get to play than in the maths she was trying to teach. I bet she imagined things would only be worse on Monday _after_ the party.

It seemed like forever for the day to come and that morning I was up much earlier than usual. I really hadn't slept all that well. I was excited about the paintball party of course. But also a bit scared. Scared that I'd get shown up by my mates. Paintball was a lot of running and jumping and shooting. I was one of the younger guys in my class and definitely not the fastest, strongest or best at any sport. I worried that I'd be one of the first ones hit and have to sit out the game while everyone else played. It was enough to give my tummy a fit and, between the fear of failure and the gnawing of my stomach, I didn't get much rest.

Even so, I paid much more attention than usual to the clothes I'd wear, finally settling on a pair of jeans, a blue and green striped shirt, and shoes that would allow me to be comfortable running through the woods or whatever. Mostly, I wanted to fit in.

I quickly made my way down to the kitchen, where Mum was fixing breakfast.

"Well, aren't you the early bird," she exclaimed upon seeing me already dressed and ready to go at a time when I was usually still in bed, especially on a Saturday. She reached out and tamped down a few stray hairs that always seemed to stick out from my head no matter how much I tried to comb them into place.

"Can't be late," I said, anxious to go even though there was plenty of time. "Trevor said the van leaves their house at nine o'clock sharp. If I miss it . . ." I shuddered to think about what would happen.

"Well, sit down and have your breakfast. It'll only take a few minutes to get there." She set a plate on the table and pointed me to a chair. "You have time for a quick bite. You want to have energy so you can play your best."

I slid into my chair and looked at the food she'd set in front of me. I was far too excited and nervous to eat. Besides, I didn't want to try racing about on a full stomach. So, I mostly stared at my food, moving bits of it around the plate.

"James," Mum said a few minutes later, pointing at my still-full plate of poached egg, smoked marlin and toast. "You haven't touched your breakfast."

I shook my head. "I'm not hungry."

"You barely had anything for supper last night. You need to eat something," she said firmly.

"I'm fine, Mum. Besides, there'll be lots of food at the party."

"And that will be several hours from now. I want you to at least eat a few bites before we go."

I picked up my fork and once again pushed the egg around my plate.

"Come on, James," Mum urged, frowning at me. "Finish up or you will be late."

My dad came into the room just as I started nibbling on my toast. "Late for what?"

"The paintball party," Mum explained, setting a bowl of Wheatabix in front of him. "Trevor's birthday, remember?"

"Right," he said in a way that made me sure he didn't remember at all. "You're taking him, aren't you?" he asked. "I have surgery until noon."

"Yes. We'll leave as soon as he eats some breakfast."

Dad looked down at my plate. It was his turn to frown. "James, it's not like you to skip meals. Are you ill?" He reached out his hand to touch my forehead.

I jerked away. There were times when I hated the fact my dad was a doctor and this was one of them. He always assumed everything was a medical problem. Yeah, I was a bit nervous and excited about the day ahead and I didn't feel like eating eggs and fish for breakfast. That didn't mean I was sick.

"Dad, stop it!" I pointedly stabbed my egg, sending the yolk running across my plate, and stuffed a small bite into my mouth. "There! I ate my egg. See!"

"Don't be smart," Dad said sternly. "Or you'll spend the entire day right here."

Oops. I was probably pushing my luck by arguing with Dad about eating the stupid breakfast. "Sorry, Dad," I said – and meant it. I forced myself to eat another few pieces of egg and toast before putting down my fork.

"Is that enough?" I asked hopefully, looking at Mum.

She glanced at my plate and nodded. "Alright, James. Go clean your teeth while I put away the dishes. We'll leave in ten minutes."

* * *

The day started out really great. Mrs. Frakes had rented a couple of vans so we could all go together – it seemed that in the end Trevor had invited almost all of the Year 6 class boys and I was pretty sure that the few who were missing either didn't like Trevor or didn't want to do paintball.

Everyone was joshing around on the ride, or as much as we could in our seatbelts. I ended up in the way back of the van, squished between Graham and Nigel. It wasn't at all like riding in my Dad's Lexus. Every time we hit a bump, we all raised ourselves out of our seats and screamed as loud as we could. Graham's mum, who was driving, kept telling us to settle down.

It was hot and, with the up and down from the bumps, the twists and turns from the curvy roads, and being crushed in the back of the hot van, I pretty much wanted to puke the entire time. By the time we got the paintball place, I was more than ready to get out.

I must have looked a little green because someone told Mrs. Frakes, who came rushing over to me.

"It's probably motion sickness from riding in the back of the van," she'd said after looking me over. "The fresh air will help. And be sure you ride up front on the way home."

I took some deep breaths, which seemed to help a bit, then ran to join the others already inside the building. I didn't want to miss out on anything.

Everyone was so excited and it didn't take long to put on the gear they gave us. We each got a cammo jacket and pants along with gloves and a helmet. I'd never worn anything like it and it was the neatest thing ever – like being a member of the SAS. Mrs. Frakes was trying to take pictures of everyone on her mobile and I hoped she got a good one of me so I could show Mum and Dad.

And then came the coolest part of all – our guns. Dad wasn't too keen on guns so I hadn't seen many up close. The ones they gave us sure looked like the real thing, even though they only shot paint. As we all stood around pointing our guns at each other, I knew that it would almost impossible to top this party. Ever.

Next the guys running the program talked to us about safety and how to play the game. They must have told us fifty times over never, ever to take off our helmets when we were in the game area. Then they showed us how to shoot and how to reload our gun and finally what to do if we were hit. We tried to pay attention but all we really wanted to do was start the game.

We had a choice of courses to play and, since it was his party, Trevor got to choose. He picked one called "Beach" something or other. We'd be divided into two teams. One team would start in a boat and head up the beach to destroy the enemy's fuel supply while the other team tried to keep them away.

I was kind of disappointed in the beach; it was totally fake and nothing like the one we had in Portwenn. Basically, they'd thrown some sand on the dirt and called it a beach. And the boat looked more like a rowboat than the "landing craft" they'd told us about. Still, it was good enough for paintball.

We had to count off by numbers to make the teams. It was better than having us choose sides because no one ever wanted to be the last one chosen and I'd been worried that might be me, which would be totally embarrassing. My group would be the attackers in the first game and the defenders in the second. We probably should have gotten together and actually planned our attack. But we had guns and paintballs and wanted to get on with it, not stand around talking.

I ended up on the same team as Graham, who happened to be my best friend in school. We decided we'd stick together, trying to cover each other as we moved forward, just like we saw guys do on the telly all the time.

The game started and it was crazy. Everyone seemed to be running around shooting anything that moved and lots of things that didn't move. There was a lot of shouting running and paint flying all about. It was fun – it was perfect. So much better than bowling or even my magician.

We scrambled out of the boat and onto the beach. There were a bunch of obstacles – fake rocks, sand brush and piles of plywood – that would let us hide from the other team trying to shoot us. We basically had to make our way up the beach until we reached the other team's fuel area.

Graham ran out ahead, and I followed him. I had to admit that shooting the paint gun was one of the neatest things I'd done. My aim wasn't too good, but with a paint gun, who cared? You just splattered whatever you wanted to and hoped you hit something. Of course, you had to be a bit careful or you'd run out of paint and spend all your time reloading.

Graham and I made pretty good progress. One of us fired at the enemy while the raced from one obstacle to the next. And then we reversed it while the other one caught up. We'd made it not quite halfway up the beach, easily keeping pace with the other guys on our team. I was feeling pretty good that I'd managed to stay alive and not slow down Graham, who was really fast and a great shot. There were moments when I wondered if he wouldn't have done better without me with him and was grateful that he was my mate.

Just when we started to get close the enemy's camp, I found myself slowing down and Graham getting further and further ahead. It seemed that all the energy I'd had only a few minutes ago was gone. Suddenly, every step was hard – like running through mud. And I was getting a stitch in my side. No matter how hard I tried, I couldn't keep up.

Graham knelt down behind a large rock and glanced back at me, curled up behind a large fake bush. "Come on, James! Let's go." He kept looking ahead to where the battle was now in full force, and I could see he was keen to get on with it.

I wanted to keep going, I really did. This game was so fun and I was so happy I'd been able to keep up and be a part of everything. And that I'd yet to get hit.

But I felt all out of sorts. My tummy hurt and I was incredibly tired. All this running about took a lot of energy, and I probably should have listened to Mum and eaten some breakfast. For now, much as I wanted to keep playing, I couldn't go on without a rest. I just had to sit down for a bit.

"Go on," I called out, waving Graham forward. "I'll catch up."

He looked at me and frowned, as if trying to decide whether to stick with me or do what I'd told him in going on without me. I urged him forward again. Finally, the thrill of the game got the better of him and, with another sad glance at me, he ran forward.

As Graham took off, I was happy to see that a couple of guys leaving the game area because they'd been hit; at least I wouldn't be the first out of the game. I stood up and turned my back to the action. If I was going to quit the game, I'd at least make sure it looked like I'd been hit. With all the paint flying, it took only a few seconds before I too was hit. As promised, it didn't hurt or even sting – it was almost as if someone had thrown paint at me.

After I left the field – being careful to keep my mask on until I was out of the firing area – I went to the loo, splashed water on my face and then sat in one of the stalls. It was the one place where no one was likely to find me. I sat there for what seemed a long while, trying to make myself feel better. By the time I came out, the game was already over. My team had won and Graham was super-excited because he'd been the one to destroy the fuel supply.

"What happened to you?" he asked me, somewhat breathless. "I thought you were behind me."

I felt bad that I'd let Graham down. "I, uh, got hit. Sorry." At least it was the truth. Mum and Dad would have been proud.

He shrugged. "No worries. Next time."

Everyone was chattering and getting new paintballs for the next round. I stood back. I couldn't do it, couldn't go out there. I'd never felt this bad before and I didn't know why. It couldn't be what I ate because I hadn't eaten anything. I looked at the clock – almost two hours until we were done here and would start back home.

As the others, now fully reloaded, headed out to the game area for the rematch, I stayed behind in the waiting area.

Mrs. Frakes came up to me. "James, aren't you going to join the next game?"

"Uh, I don't think so."

Her eyebrows tightened in concern. "You're not hurt are you?"

"No, I'm just, uh—" What should I tell her? "I just don't feel so good. Probably from the car ride," I added.

Her frown deepened. "Oh dear. Maybe I should call your father."

No, no, no. Oh gawd no! I couldn't let her call him. I could just see my dad arriving in his suit and with his medical case and making a big scene. He'd either examine me on the spot or drag me off to his surgery. In front of all my mates, no less. It would be humiliating. It's all anyone would talk about for weeks. I'd never live it down. No, I'd have to be dying before I let Mrs. Frakes call him.

"It's okay, Mrs. Frakes," I said, with as much energy as I could muster. "I just need a bit of fresh air. I'm sure I'll be right as rain when it comes time to eat the cake and ice cream."

"Well, I don't know." She continued to frown and I returned it with a smile. She seemed to brighten at my effort. "All right, then. But if you start to feel any worse, you let me know straight away."

She went back to taking pictures and I went to the loo and threw up everything I had, which wasn't much. And hoped the next two hours would pass much faster than the last two.

* * *

Glossary:

SAS: Special Air Service, a British special forces unit


	3. Chapter 3

**Author's Note: Thanks so much for the reviews and comments. I apologize for not replying to each individually, but know that I do read and greatly appreciate every one!**

* * *

From Trevor's bedroom where I now found myself, I could hear the squeals and shouts of the party going on below. It sounded like Trevor was opening his presents. Everyone seemed really excited which must mean he was getting some cool stuff.

I'd so looked forward to the party and now . . . now I'd ruined everything. At the paintball place, I'd hoped that I was just a bit out of sorts and, by the time we got back to Trevor's house, I'd feel better. I didn't. I was really sick. I knew it and Trevor's mum knew it. This time when she said she was going to call my dad, I didn't try to stop her.

I curled up on my side, as it was the most comfortable position I could find. Mrs. Frakes stared down at me, clearly having no idea what to do with a sick kid upstairs and a room full of boys having a party downstairs.

"Well, you don't feel hot," she announced after placing the back of her hand against my forehead. "That's good."

I nodded, not sure what I was supposed to say or do at this point other than hope my dad would get here soon and sort me out.

"Will you be alright for a few minutes while I check on everyone downstairs?" she asked in a way that suggested she was afraid to leave me alone, even for a minute. Was I that bad off?'

"I'll be okay." After all, her staring at me and fretting wouldn't make me better and was only making me feel worse about all the trouble I'd caused.

"I'll be back in a minute. I'll leave the door open so if you need anything, just shout. I'm sure Dr. Ellingham will be here shortly." Mrs. Frakes gave me one more worried look then headed back down the stairs.

In truth, I was starting to fret a bit myself. I'd been sick a few times – colds and even the flu once - but never like this. My tummy really hurt and I mostly wanted to throw up again. I swallowed hard and tried to think of something else.

Trevor's mum had only been gone a few minutes when I heard the doorbell ring. Trevor's dog Brandy started barking like mad and Mrs. Frakes shouted at him to be quiet.

"Dr. Ellingham, am I glad to see you," Mrs. Frakes said loudly enough for me to hear. "You got here so quickly—"

"Where is he?" Dad bellowed from the doorway and, as usual, he hadn't bothered with the "hellos" and "how do you dos."

I'd never been so happy and relieved to hear my dad's voice. He was the best doctor anywhere and, whatever it took, he'd fix me up straight away.

"Trevor's room," Mrs. Frakes answered loudly. "Upstairs. First room on the right."

In short order, Dad stepped into the room, dressed in his usual dark suit. His medical gaze swept over me and he must have seen something that he didn't like because his eyes pinched together and his mouth seemed to frown. Over Dad's shoulder I saw Mum hovering in the doorway.

"James, are you alright?" she asked.

"Of course he's not alright," Dad answered for me. In what seemed to be a single motion, he grabbed Trevor's desk chair, swung it around, and seated himself next to the bed, setting his medical case on the desk.

"James." His voice was perfectly calm, as if he were talking to any patient. He looked down at me and, when I saw a slight mist in his eyes, I knew I wasn't just any patient.

"I'm sorry," I started. "I'm sorry I got sick, and that I ruined the party and that you—"

"Shush," Dad said, but there was no anger in his voice. He pressed his left hand against my forehead and the fingers of his right hand wrapped firmly around my wrist. "Tell me what's wrong."

"My tummy hurts a lot. And I feel sick."

Mum stepped into the room. "Martin?" she asked, sounding kind of scared.

Dad's eyes never left mine. "When did you start feeling sick?"

I tried to think. I knew it was important to answer my dad's questions as best I could. "Yesterday, I guess. But it wasn't bad until this morning," I added without looking Mum.

"Oh, James," she said. "Why didn't you tell me you were sick? I should have known when you didn't eat your breakfast. I should never have let you go—"

"Not now, Louisa," Dad said as he pulled several instruments from his bag. The first thing he did was check my temperature in my ear. It only took a second and, when Dad saw the result, he only grunted.

"Is he running a fever?" Mum asked.

"Low grade," Dad replied, taking his torch and a tongue depressor in hand and checking my throat. "Tell me how you felt this morning."

I swallowed hard to get the taste of the wooden stick out of my mouth. "My stomach hurt a bit."

"Has it been hurting all day?"

I nodded.

"Getting worse?"

I nodded again.

Dad sighed. "When did you last eat?"

"I had a bit of supper last night."

"He barely touched his food," Mum added.

Dad put his stethoscope in his ears. "Have you vomited?"

Another nod. "At paintball."

"Any diarrhea?"

I shook my head no, thankful it was the truth. I kind of wished Dad would stop asking me questions and do something to make me feel better.

Dad listened to my back and chest, then pushed up my shirt and undid my jeans, sliding them over my hips and exposing my belly to the cold room air. He used his stethoscope again, placing it on my tummy and listening for what seemed like forever.

Finally, he pulled the stethoscope from his ears. "Show me where the pain is."

I pointed to a spot on my right side. "Here."

"Alright, James. I'm going to press on your abdomen. It may be a bit uncomfortable, but I'll be as gentle as I can."

He started with my left side, eyes fixed on mine. As always, his hands were both firm and gentle at the same time. "That hurt?" he asked and I shook my head.

He pressed lightly in a few more places, saving the spot on my right side where I'd told him it hurt for last. That was a good thing because as soon as he touched it—

"Ow!" I tried to push away his hands. "Dad! That hurts!" It did, really bad.

I heard Mom gasp and move closer to the bed. "Martin, what are you doing to him?"

Dad didn't answer her and instead grasped my hands tightly in his. "That's all." His eyes misted again. "I'm sorry, James," he said softly, and I knew he meant it.

I figured Dad was done examining me and once again curled up on my side, which made it hurt less. Mum came to sit on the bed next to me and stroked the hair off my face. "It's alright, James," she said. "You're going to be just fine, isn't he Martin?"

"Yes." Dad pulled out his mobile and quickly dialed. It seemed like only seconds before someone answered. "Penhale, it's Dr. Ellingham. I need you to come to the—" He turned to Mum. "What's the surname of the people who live here?"

"Frakes."

"The Frakes home. Do you know where it is? Good. I need you to drive James, Louisa and me to Truro hospital. Immediately."

PC Penhale must have said something stupid because Dad rolled his eyes. "I don't have time to explain. Just get here."

Apparently finished with the call, he looked down at me. "James, you have an infection in your belly. We need to take you to hospital."

"Martin, what is it? What's wrong?" Mum asked.

Dad turned around to face her. "Most likely appendicitis." He reached into his medical case again.

I wasn't entirely sure what appendicitis meant. I seemed to remember that Ella Smythe, who was a fourth year, had appendicitis last year and had been out of school for about a week. Is that what would happen to me?

"Why do I have to go to hospital?" I asked. I'd never been to hospital before and it sounded awfully serious.

"They'll need to do some special tests and you may need to have an operation."

"Why did you call Joe?" Mum asked before I could say anything more. "Can't you drive to Truro?"

Dad busied himself with his medical equipment. "I need to put a line in him and I'll need to monitor it during the drive."

What did he mean by "put a line" in me? I was scared and confused and wished Dad would explain himself.

"I could drive," Mum offered.

"Uh, no. I mean, time is of essence and Penhale, uh, has a police car. It'll be faster," he added.

Dad stretched out my arm until it was straight and asked Mum to hold it steady. "Okay, James. I'm going to insert an intravenous line so I can give you medicine straight into your vein. You'll feel a little stick when the needle goes in."

At this point, I felt so bad that I wasn't about to complain about anything Dad did to make me feel better or even to ask the questions I'd usually ask when he was taking care of me. I just wanted him to be done with it.

Dad swabbed my forearm then reached for a needle. I knew about my dad's blood thing and hoped he didn't throw up in Trevor's room. Thankfully, he was steady as a rock. It was Mum who scrunched up her face and looked away when Dad slid the needle into my arm. Dad was right – it hurt for a second and that was it.

"What's that?" Mum asked Dad attached a clear bag of liquid. I had the same question.

"Fluids." Dad said to Mum then looked at me. "You're dehydrated." I must have seemed confused because he quickly added, "this will make you feel better, stronger."

Dad pulled out a vial and another needle. I couldn't help but bite my lip – I was tired of being poked and stuck. Dad must have noticed because he put his hand on my arm and his eyes locked on mine.

"James, this is something for the pain. I'm going to put it directly into your drip. It won't hurt."

He was right; it didn't hurt. And even better, almost instantly, my pain was gone. For the first time in two days, I felt . . . well, better. I knew my dad was the best doctor ever. I let my eyes close. The last things I remembered were my dad's fingers pressed against my neck and my mum's hand tightly holding mine.


	4. Chapter 4

I'd spent nearly my entire adult life in hospitals. From the time I was a young medical student to my years as a registrar, surgical consultant, then chief of vascular surgery, hospitals were where I had learned, and then perfected, my craft. I'd worked, eaten and often slept in these large impersonal buildings.

Hospitals had a certain order of process and hierarchy that fit with my view of the world. You didn't have to like your colleagues or even be liked by them. The only thing that mattered was how well you did your job. Everyone worked toward a single goal of saving or improving the lives of patients. When I walked down a hospital corridor, I felt at ease and even accepted. The antiseptic smells, tile walls and corridors, crisp uniforms, hushed tones, and buzzing machinery were more comforting and familiar to me than my own home.

Most of my patients either feared or loathed hospitals, and it was a constant struggle for me to convince them that a stay in hospital was in their best interests. I found their views to be idiotic and often told them as much.

My perspective changed the moment I carried James into the Turo A&E department.

I'd called ahead from the car to report James' condition and our ETA. Thus, it wasn't surprising that a nurse and registrar were waiting for us right inside the entrance to the A&E.

"Ten-year-old male with suspected appendicitis," I reported. "Pain in the lower left quadrant, anorexia since yesterday, low grade fever. I've given him morphine and started him on ceftriaxone and metronidazole." The familiar litany helped take my mind off the fact that I was reporting on my son and not some random patient.

"We've got him, Dr. Ellingham," the registrar said as she took James from my arms and settled him on a gurney. "You and Mrs. Ellingham can stay with him for now."

Louisa and I followed along, and I was thankful to whomever had decided to allow parents to stay with their child in A&E rather than forcing them to wait outside. I wanted – needed – to ensure James received the best care possible.

A queasiness settled in the pit of my stomach as we walked down a short corridor into one of the curtained cubicles. This hospital, where I'd admitted patients and occasionally worked for nearly fifteen years, suddenly felt like a foreign country. What had set me on edge was a loss of control. My son, my only child, was in hospital because he needed surgery. The surgery itself wouldn't be complex but, without it, he would die. It was just that simple. And whether James walked out of this hospital or not was not up to me. Louisa and I would have to trust the skill of the medical personnel in this hospital – and especially that of the surgeon who would operate on my son – to save his life.

The thought terrified me. It shouldn't have, given that I myself had been a surgeon for many years. In those days, I'd been the one to whom patients had entrusted their lives. Many times, neither the patient nor his relatives had even met me before the day that I would operate. They had no sense of my competence and had to trust that I would save their life. I'd had full confidence in my surgical abilities; I'd never given any thought to the fact my patients might not always share that confidence.

I watched carefully as the A&E team got James settled. They helped him change into a hospital gown and took his vital signs. I couldn't help but notice that the nurse and technician talked to him throughout, explaining what they were doing and making sure he understood that it wouldn't be painful.

"He'll need a white blood cell count," I said.

The nurse gave me an annoyed look. "We know what we're doing."

Louisa was clearly nervous, doing her best to stay by James' side while at the same time staying out of the way of the medical personnel attending to him.

"Where's the surgical consultant?" I asked.

"On his way," the nurse reported.

"Dad?" James's eyes roamed from his intravenous line, to the medical personal, to the various monitors flashing overhead – then settled on me. "Why do I have to stay here? Can't we just go home and you fix me up?"

Beside me, Louisa gulped. I stepped closer to the bed. It was clear that fatigue, the strain of the day, and the morphine were starting to take their toll on my young son. And, I suspected, fear. As a doctor, I'd typically dismissed such fear in my patients. I couldn't do the same with James. So I did what I always did when my son was frightened or anxious – I turned to calm, didactic explanation.

"James," I started. "There's a very small organ in your abdomen that is infected and causing you pain. You need a special doctor, a surgeon, to take it out, here in the hospital."

"I'm not in pain anymore," he announced, clearly trying to look and sound braver than he felt.

I sighed. "That's because of the medicine I gave you earlier." I glanced at my watch, frustrated at the continued delay.

"Will it hurt?" James asked.

"The surgery? No. They'll give you medicine so you'll sleep right through it."

His eyes narrowed and the fear reasserted itself. "What if I wake up, like I did last night, and it hurts?"

"You won't."

James seemed torn between accepting my explanation and challenging me some more.

Louisa grabbed his hand. "You're going to be just fine, James," she said and I knew she was fighting not to cry in front of him.

"There will be a special doctor who will be with you throughout the surgery to make sure you stay asleep during the operation and that you wake up as soon as it's over."

"Consultant's here," I heard someone say from outside the cubicle.

The curtain swished open and I couldn't restrain the gasp that emerged from my lips at the sight of the surgeon.

It was my old nemesis and former student, Adrian Pitts. Beside me, I heard Louisa smother a "no."

Pitts glanced at me and, for a brief second, we locked eyes. I'd expected to see loathing or even condescension in his. Instead, I saw something that, had I not known Pitts so well for so long, I might have pegged as sympathy.

"Dr. Ellingham," he said formally, with the slightest emphasis on the word "doctor." "I understand it's a case of suspected appendicitis."

" _It_ ," Louisa said pointedly, "is our son, James."

"Right," Pitts replied, his eyes glued on mine.

I started to repeat the information I'd given to the A&E team regarding James' history and symptoms. "Pain at McBurney's point—"

Pitts cut me off. "I did read the chart." He glanced at the IV. "You started him on ceftriaxone. Confident in your diagnosis, are you?"

"Yes." I replied and felt Louisa's hand tugging at my jacket.

Pitts started to say something more then seemed to think better of it and, instead, moved closer to my son's stretcher and peeled back the bedsheets. Whether it was the presence of yet another stranger or exhaustion from constant poking and prodding, James started to pull away.

I couldn't help but notice that Pitts had yet to speak a word to his patient or to Louisa – and the few words he'd directed at me were as a fellow physician and not the patient's father. Watching Pitts harkened me back to my own days as a surgical consultant. Like him, my focus had always been on my patient's medical status and the procedures I'd need to do perform to restore my patient to full health. I'd spared little time or energy actually talking to my patients – or their families – beyond the required explanation of the surgery to come.

In those days, I'd never considered – or even cared – how my patients or their families reacted to me. My job was to apply my surgical skill to their arteries and

veins, not to hold their hands, soothe their anxieties, or provide reassurance.

I'd never before thought about it from the other side of the bed . . . until now. Viewed from the perspective of a former surgeon, Pitts' conduct wasn't surprising or unusual. I could see that Louisa and James felt differently. They were frightened and the fact that Pitts might be a competent surgeon wasn't enough.

One of the nurses stepped forward. "James, you need to let Mr. Pitts have a look at you."

"No, I don't want him. I want my dad." He turned to me. "Dad!" he cried and I wasn't certain whether it was from fear or pain or both.

"Martin!" Louisa hissed.

Ignoring her for the moment, I stepped to the bed and laid my hand on my son's forearm. "James, Mr. Pitts is a—an expert in surgery. He's going to take good care of you."

"I want you. Why can't you take care of me?"

This clinging was unlike James. He'd been treated by his pediatrician and other doctors many times in his life and had never acted like this. His response was no doubt yet another byproduct of fear and anxiety. Across the bed, Pitts gave me an exasperated look. It was clear he wanted to get on with it. I ignored him and focused my attention on my son.

"James," I said more firmly this time, "Remember we talked earlier about how you'd need an operation. Mr. Pitts is a surgeon – a special kind of doctor who's going to help you get better. But you need to let him examine you. I'll be right here," I added, flicking my eyes to Pitts' face and daring him to contradict me.

James seemed to relent and, to his credit, Pitts made short work of the examination. He was careful and between that and the morphine I'd administered, managed to cause James less pain than I had with my own probing.

Pitts pulled the sheet over James' torso and gave the boy a pat on the arm. "All done. You did well, young man." He looked at me and tilted his head, inviting me to join him outside the cubicle.

"James," I said, "I'm just going to have a quick word with Mr. Pitts. I'll be right back."

"I'll stay with you," Louisa said, giving me a dark look.

In the hallway, Pitts was the first to speak. "Given his symptoms, physical exam, and elevated white count, it's almost certainly appendicitis. I still want to confirm with contrast CT."

His approach made sense and I nodded my approval.

"I'll order a room in theatre and, as soon as we have the CT results, I'll operate straight away."

"Will you use an open or laparoscopic procedure?"

There was something almost normal in our conversation and, for the moment at least, it appeared that our awkward history had been put aside.

"Laparoscopy. I've had excellent results and, as you know, it has fewer complications and decreases hospital and recovery time."

In my days as a surgeon, appendectomy was almost always treated with open laparotomy. In the intervening years, surgeons had largely transitioned to a laparoscopic approach, though many still used the open procedure with children because it required more delicate and sophisticated technique.

"How many have you performed?" I asked. In surgery, frequency and proficiency were typically linked.

If Pitts took offense at my question, he didn't show it. "Several hundred laparoscopically, and more than fifty in children."

"Hmm." It was an acceptable number as Pitts well knew.

"I'll come find you once I have the CT results."

After Pitts took his leave, I returned to James and Louisa. James' vital signs looked good and his eyes were closed – likely a combination of medication and exhaustion.

Louisa gave me a pointed look. "Martin, a word."

I had a pretty good idea what she wanted to talk about and doing it in front of our son wasn't a good idea.

I reached for James' hand and gave it a tight squeeze. "James, your mum and I are going to step outside for a moment."

"No!"

"James, it'll be alright" Louisa said softly, "we'll be right outside. And we'll be back before you know it."

"I want you to stay with me."

One of the nurses stepped forward, a huge smile on her face. "James, we need to go take some pictures of you in another room. We'll do them really quick so that we'll be all finished by the time your Mum and Dad come back."

James looked slightly panicked. "Can't my mum and dad come with me?"

"It's a very small room so it would be too crowded."

I gave my son a reassuring look. "It's alright, James. They're just pictures – it won't hurt. Your mum and I will be right here when you get back."

* * *

Glossary and Author's Notes:

Registrar – junior physician, roughly equivalent to a junior resident in the U.S. system.

Ceftriaxone and metronidazole – antibiotics that can be given prophylactically when appendicitis is suspected in order to stave off sepsis (infection) if the appendix bursts before it is removed

McBurney's point – a location in the lower right quadrant of the abdomen. Pain in this region is a key symptom of appendicitis.

Laparoscopic vs. open appendectomy – In the past, appendicitis was always treated by making an incision in the abdomen and removing the appendix through it (an "open" procedure). More recently, laparoscopic technique has become the preferred choice for many surgeons. There are quite a few medical articles debating which procedure is "better" for uncomplicated appendicitis, especially in children and I've condensed that debate into a few sentences in the story. Today, both procedures are still used and the choice rests with the surgeon. My sense is that, a decade from now (when this story is set) laparoscopic appendectomy will be much more common than it is today.

Antibiotic treatment is yet another approach gaining favor in treating uncomplicated appendicitis, especially in children. Under this approach, the patient is given IV antibiotics in the hospital for about a day and then sent home on a course of oral antibiotics. In most cases, the appendicitis never returns and surgery is avoided altogether. However, there are some drawbacks. First, hospital time is not reduced because the time spent in the hospital getting the IV antibiotic treatment is about the same as having laparoscopic surgery. Also, in up to 30% of the cases, appendicitis returns and surgery is required. Thus, these patients have to undergo an "unnecessary" second set of symptoms and second hospitalization when the problem could have been taken care of the first time with surgery. Finally, the studies have followed patients for only one to four years after antibiotic treatment, so it is still unknown whether antibiotics are successful in preventing a recurrence of appendicitis in the long term. Antibiotic treatment vs. surgery has been the subject of numerous recent medical journal articles (including one in the _British Medical Journal_ earlier this year), with most authors concluding that more research is needed. Given that Doc Martin reads his medical journals, in "real life," he would have discussed the antibiotic therapy option with Pitts. For story-telling purposes, I didn't have that conversation occur.


	5. Chapter 5

As soon as we were out of earshot of the A&E area, Louisa pounced on me. "That man," she said between clenched teeth, "is not going to operate on our son."

"Louisa, Pitts is a more than competent surgeon."

"He's an arse. After the way he treated you, I wouldn't let him operate on a goldfish."

I sighed. "I agree he's an arse, always has been. He also happens to be the surgical consultant."

"I don't care. He despises you, Martin, and me as well."

I couldn't hide my surprise at her statement and voiced my thought aloud. "Why would he despise you?"

Before she could answer, Chris Parsons came scurrying up to us. "Martin, Louisa, I just heard that James was admitted to A&E. What happened?"

"Appendicitis," I replied crisply. "They're doing the CT now."

Chris gave us a tight smile. "Good to hear it's nothing more serious than that. Who's doing the surgery?"

I swallowed hard. "Adrian Pitts."

"No he's not," Louisa responded, glaring at us with arms crossed tightly over her chest.

Chris looked between us, confusion evident on his features. "Uh, why don't we go to my office to talk about this?" It was clear he didn't want to have this conversation in the hallways of Truro hospital.

Chris's office was only a short walk from A&E and, a few moments later, we were seated in front of his desk. Louisa, I couldn't help but notice, perched on the front edge of her chair, ready for combat.

"So, what seems to be the problem?" Chris leaned back in his chair, his eyes again flickering between Louisa and myself.

Instead of answering him, Louisa turned to me. "After what he did, how can you think of letting him operate on our son?"

Chris raised an eyebrow, clearly confused and I was torn between addressing his question or responding to Louisa.

Before I could answer either of them, Louisa jumped in. "He told all of Portwenn about Martin's . . . blood thing."

I saw Chris wince at her words. "It was a long time ago," I added. "Before James was even born."

"I don't care," Louisa said. "It was spiteful. He wanted to hurt you."

It had been more than a decade ago when Pitts had showed up in Portwenn hoping I'd give him a recommendation for a surgical post. When I'd refused, he'd retaliated by publicizing my blood phobia to the denizens of the local pub. The experience had been humiliating and, even years later, the memories of that day were still painful.

Louisa wasn't finished. "You saw him today; he hasn't changed a bit."

"Louisa, Pitts may be a despicable human being but he also happens to be a fine surgeon. We need him to take out James' appendix, not to be his nanny."

I hated to be the one to defend Adrian Pitts. During my years in Portwenn, he'd operated on more than a few of my patients and I had to admit that his surgical skill was first-rate. I'd taught him well. I knew the other general surgeons in the area and none matched Pitts in terms of technical ability. And, patients actually liked him. He said and did all of the right things, even though it was probably for all the wrong reasons.

"It's not just about skill, Martin."

"That's exactly what it's about, Louisa. It's surgery, not a popularity contest."

I had no doubt that, in my years as a surgeon, many of my patients – and even some of my colleagues – hadn't liked me either. And, while I'd not been as obnoxious as Pitts, I certainly had been demanding, exacting and, most of the time, far from congenial. No doubt, at least a few colleagues and patients probably considered me to be an arse.

I couldn't have cared less. Whether people liked me or didn't like me was irrelevant. What mattered – the only thing that mattered – is that I was an excellent surgeon with the expertise to perform the vascular repair they needed.

The fact was that, in theatre, surgical skill was all that counted. For now, given the limited options on a Saturday night in Truro, I'd take my chances with Pitts, if for no other reason than he'd have a narcissistic need to impress me.

Louisa interrupted my thoughts. "It _is_ about not letting him cut into our son."

Chris raised his hands. "Alright, alright." He took a deep breath then focused his gaze on Louisa. "I agree with you that Pitts has some . . . personality challenges, especially when it comes to dealing with Martin."

"He's nasty," Louisa said under her breath and Chris pointedly ignored the comment.

"I also have to agree with Martin that the man is a talented surgeon. Pitts knows what he's doing in theatre. And right now, that's the most important thing for James. You don't need to like him, Louisa—"

"But I do have to trust him. And I don't trust Adrian Pitts as far as I could throw him. He hurt Martin terribly and enjoyed every last minute of it."

"Louisa." Chris' voice was soft. "I'm not even going to try to excuse what Pitts did and the harm it caused. I can only tell you that, since that happened, he has matured . . . a bit."

"Chris, if it were Dan in the A&E tonight," I said, referring to Chris's own son, "who would you have perform the surgery?"

Chris looked me straight in the eye. "I wouldn't choose him as my GP and I certainly wouldn't invite him to my home for dinner. But if my son needed an appendectomy tonight, I'd want Adrian Pitts to do it."

It was a strong statement and one that even surprised me a bit.

Louisa slouched in her chair. "Oh, I don't know!"

Chris stood up and came around the front of his desk, perching on the corner nearest Louisa. "Louisa, when Dan was about James's age, he had hernia surgery. So I know what it feels like to have your only child face surgery. It's one of the most frightening things ever to trust another human being with your son's life, especially someone like Pitts who's caused you and Martin so much pain. But you need to do what's best for James."

Louisa nodded, tears in her eyes. "Oh, Martin, if something happens to James . . ."

"Sshh," I said softly. I stood up and gently pulled Louisa to her feet, wrapping my arms tightly around her, hoping to impart to her some of my strength. And hoping the trust Chris and I had in Adrian Pitts was not misplaced.

* * *

It was the hardest thing I'd ever done. Harder than leaving surgery. Harder than having Louisa leave me at the altar. Harder than not knowing for a long time that she was pregnant. Harder even than hearing my mother tell me she hated me.

It all started when we returned to James' cubicle. With the results of the CT having confirmed the diagnosis, preparations for surgery were well underway. Dr. Kingston, the anesthesiologist, was already there, performing her assessment. I'd heard uniformly good things about her and gave an internal sigh of relief that she'd be the one responsible for my son's anesthesia.

"Have you had anything to eat or drink today?" she asked James.

I resisted the urge to answer for him. Who knew what he might have eaten at that stupid party?

"I tried to eat some eggs this morning, but I mostly pushed them around my plate," he added with an impish glance at Louisa.

She smiled down at James. "Do you have any questions for me?"

"My dad said I won't wake up in the middle of my operation," he asked in a tone daring her to contradict my earlier pronouncement.

Her eyes flicked to me. "Your father is absolutely right. You'll be sound asleep during the surgery and then, as soon as it's over, you'll wake up straight away. Your mum and dad will be there when you wake up."

James smiled and looked at Louisa and me. "Really?"

"Of course we will," Louisa said.

"Yes, James," I added.

Kingston then went over James' medical history with me and I succinctly answered her questions.

"Will you be using endotracheal intubation?" I asked when she appeared finished.

"Yes."

"What medications do you intend to use?"

"I prefer sevoflurane and propofol along with nitrous oxide."

I nodded. The drugs were both short-acting agents and the use of nitrous oxide was not counter-indicated.

"Do you anticipate post-operative nausea and vomiting?"

"Martin!" It was Louisa's voice. She nodded toward James, who'd apparently been following our discussion. He looked concerned.

"Dr. Ellingham," Kingston's voice had turned icy. "I know my job."

Even though I had full confidence in her abilities, I couldn't help double-checking, just as I had with the surgeon who intended to operate on Louisa. This was James; I had to be certain.

Kingston stood up without answering my question or giving me the opportunity to ask more. "I'll see you in a bit, James."

As soon as she left, Louisa spoke softly to our son. "James, your father is just making sure you get the absolute best care possible, isn't that right, Martin?"

"Yes."

"There's nothing to worry about, is there?" she asked, giving me a pointed look that told me I'd better answer this in the right way.

I touched James' cheek. "Of course not. Everything is going to be fine."

Within minutes, a nurse brought in the surgical consent form. Normally, Pitts would go over the form with the patient's family. Having explained surgical procedures to thousands of patients, I didn't need that nor did I even need to read it to know what it said. I was familiar what would occur to my son in theatre as well the potential surgical and anesthesia risks.

I blew out a long breath and signed the form.

Almost immediately, the surgical team arrived to take James to theater. They disconnected him from the leads recording his vital signs, placed his IV bags on his stretcher, and wrapped the blankets tightly around him.

"Time to go," one of the medics announced, making clear Louisa and I needed to say our good-byes.

I'd watched James throughout the process and, despite his outward bravado and our reassurances, our son was anxious.

"Mum," James clung to Louisa's arm. "I don't want an operation. Can't I just go home?"

"Martin!" Louisa hissed at me.

I motioned for the medics to wait and I took James' hand in mine. "James, remember I told you that I was once a surgeon myself." I was rewarded with a slight nod.

"I would wait in operating theatre for my patient to arrive, just as Mr. Pitts is ready for you. And when I was waiting, I thought about the fact that my patient was ill and needed my help to get better – just as you need Mr. Pitts' help."

James seemed to be listening. I surreptitiously slid my fingers so as to feel his pulse and was pleased to see it was approaching normal.

"As a surgeon, I understood that my patients and their families trusted me to make them well again. They might be scared, but I wasn't. I knew I could help them. There are many people who are going to make sure that you get well. And your mum and I will be waiting right outside while you're in theater and be right next to you when you wake up."

James nodded and I could have sworn I heard a small sob from Louisa. I kept my eyes on my son.

"So you need to be very brave and do exactly what you're told. If you do, it will all be over very soon and you'll be feeling much better. Can you do that?"

James swallowed hard and gave me a nod.

"Good," I said, forcing a smile. I squeezed his hand one last time, Louisa gave him a kiss and, a moment later, he was gone.

"Martin, that was beautiful," Louisa said.

No, I thought to myself, it was hard. The impotence of placing my son's life in the hands of another doctor was without a doubt the hardest thing I'd ever endured.


	6. Chapter 6

Surgical waiting rooms, I decided, were horrid places – and the one in which Louisa and I found ourselves was no exception. It wasn't so much the room itself, with the slightly uncomfortable chairs, patient informational pamphlets, and magazines that dated from the last decade. Or the large TV hanging from the wall, muted, and tuned to the BBC.

No, it was the palpable nervousness and fear that permeated the room and its occupants. There were two other families in the room when we entered, both looking stressed and concerned.

"Chris said we can wait in his office, if you'd prefer," I offered.

"No, Martin. I want to be here. I _need_ to be here, close to James."

Years ago, I would have pointed out that where we sat to await word from Pitts would have no effect on our son or his surgery. By now, I knew better and remained silent as I led Louisa to a nearby chair.

"How long will the surgery take?" she asked.

"About an hour."

"Will he have a scar?"

"Not much of one and it will fade with time. Pitts is doing a laparoscopic procedure. He'll make a series of very small incisions in the abdomen and then insert a camera and instruments. He'll cut away the appendix and remove it through one of the incisions. There's less scarring and less recovery time than with an open procedure."

"Right."

"James is going to be fine."

"You don't know that, Martin."

I could cite to the statistics that showed that uncomplicated appendectomy was one of the safest surgical procedures with universally excellent outcomes. That wouldn't be persuasive to Louisa and, I had to admit, it wasn't all that comforting to me. All the statistics in the world wouldn't matter if anything happened to James.

Knowing exactly what was happening to him didn't make the waiting any easier. I tried not to think about the breathing tube being inserted or the paralyzing drugs being administered or the betadine wiped over his abdomen. And especially not the gowned and gloved Adrian Pitts cutting into my son's skin.

The waiting room door opened and Chris stepped inside, holding two cups of coffee. He came over to us and handed one to Louisa and the other to me.

"Thanks, but I don't like hospital coffee," I said.

"Oh, right. I'd forgotten. I guess that makes this mine then." He sat down across from us and took a sip from the cup. "Thought I'd let you know that Pitts just started."

I nodded. Timing seemed about right.

"Anything I can get you? Like a decent magazine? Or the BMJ?"

Louisa and I both shook our heads.

"Chris, you should go home," Louisa said.

"She's right," I chimed in. "Nothing to be gained by staying here."

"Sorry. Can't get rid of me that easily."

We sat in silence and I resisted the urge to check my watch every few minutes. Chris and Louisa had finished their coffees when the waiting room door opened and a man clad in scrubs walked through.

I tensed for a moment, knowing James' surgery couldn't have already been completed – at least not successfully – then relaxed when I watched the man approach one of the other families. It was the neurosurgeon and, from what I could make out, the news wasn't all good.

"MVA," Chris filled in once the family had left the waiting room. "Motorbike versus lorry. It's a miracle the rider wasn't killed on impact."

The minutes ticked by and I tried not to fidget. Or worry. I thought about all of the times I'd been in theatre while my patient's relatives sat in rooms like this, waiting for me to arrive and make my pronouncements. I'd never given much thought to what they'd been thinking or doing in the hours I'd worked on my patient.

Louisa glanced at the clock and I followed her gaze. It had been about a half-hour since Pitts had started. I don't think any thirty minutes have ever seemed to take this long.

"More coffee?" Chris finally asked.

Louisa nodded, holding out her cup. "If it's not too much trouble."

Once he'd left she turned to me. "How did you ever do this every day? As a surgeon, I mean."

I shrugged. "It's a bit different – easier – when you're in theatre." It was hard to explain to Louisa that, when I'd been a surgeon, surgery was simply my job. A technically demanding and difficult job, of course, but also something I'd trained for my entire adult life.

"I suppose so. But knowing there are worried families waiting . . ."

In theatre, I'd focused on performing each surgical procedure to the best of my ability. I spared no thoughts or energy on anything else. And, when I'd finished, talking to the family was merely another task as the lead surgeon. I was moved by neither their gratitude or tears. Not until my very last procedure, with the elderly woman, did I ever stop to consider what my patients' families were enduring while I was in theatre. And that had been my downfall.

The sound of my mobile shattered the silence of the room and I fumbled in my pocket to answer it and silence the ringing. No doubt some villager with a hangnail, hangover, or just hankering to interrupt what they undoubtedly thought was a routine Saturday evening with my family.

"Ellingham." I didn't quite manage to keep the annoyance out of my voice.

"Doc, it's Morwenna. It's Emma." Morwenna was trying to stay calm, but I could still hear the panic in her voice.

Emma was the five-year-old daughter of Al and Morwenna. She also happened to be my goddaughter. It was still somewhat of a mystery to me how Louisa had managed to convince me that being a godparent to any child was a good idea.

"What's wrong?" I asked.

"She's fell off her bike," Morwenna continued. "It was her first day without training wheels and I was running along side her and suddenly she hit a bump in the road and the bike—"

"Morwenna!" I had to say it twice to get her to stop. "What happened to the child?"

"She's got a cut on her leg and it won't stop bleeding. And she says her arm hurts. And her head."

Louisa gave me an annoyed look, obviously unhappy that I was taking a call while our son was in surgery.

"Was Emma wearing a helmet?" I asked, intentionally using the girl's name to let Louisa know this was a call I needed to take, even under these circumstances.

"Yes. Of course, Doc. I wouldn't let her ride without one."

Well, that was good news but a concussion was still possible.

Parsons re-entered the room with a paper cup in each hand. He walked toward us, frowning when he saw me on the mobile.

"Is she experiencing any dizziness or problems with balance?"

"I'm not sure; I don't think so."

I sighed in frustration. "Is she confused? Having trouble concentrating?"

"Oh dear," I heard Louisa mutter. Having spent more than a decade as a GP's wife, she'd learned more than a few things about medicine, including concerns about concussion.

"No. I don't think so," Morwenna answered. "I don't know! Is it important?"

"Of course it's important or I wouldn't ask. Go check. Ask her some simple questions and check to see if she's sensitive to light."

Chris handed Louisa one of the coffees and sat down across from us. "Martin, what's wrong?"

"Five-year-old child who took a fall from a bicycle."

"Confusion and concentration," Chris mused. "You're thinking possible concussion."

I nodded, impatient for Morwenna to return.

A few seconds later, her breathless voice was on the phone. "It's hard to tell, Doc. She was crying a lot at first. And now, I think she's in a lot of pain."

Mentally, I cursed. The child could have a concussion and fractured arm and need stitches for the laceration. Or she could simply have bumps, bruises and a scrape that would heal on its own. The only way to sort it out would be to examine her.

"Can you bring her to hospital?" I asked.

"Hospital! Oh my God. Doc! What are you saying? Is it that serious?"

"I don't know without examining her. Can you bring her to the hospital?" I repeated.

"I can't, Doc. Al's got the car. You see he's in Wadebridge. It's poker night."

Good Lord.

"Doc, can't you just come over?"

"I'm in Truro," I replied, somewhat surprised that she – and the entire village – didn't already know of James' situation. Penhale must be slipping. I told Morwenna to hold on and put my mobile on mute as I mentally reviewed the situation.

The child needed to be examined – soon. I was in Truro without a car. Morwenna didn't have a car. The nearest GP was in Wadebridge and might not even be available on a Saturday night. Under any other circumstances, I'd get a taxi and see to Morwenna's child. Tonight, doing so meant leaving my own, still in surgery.

I thought about Morwenna, alone and scared with an injured child. I thought about Louisa waiting by herself in this miserable room for James' surgery to be over. I thought about my not being present when my son woke up from the anesthesia. And I thought about my duty as a physician. I made my decision.

"Chris, can I use your car?"

"Of course," he replied immediately. Then, a beat later, "For what?"

"I need to see to the child."

"Martin!" It was Louisa. "What are you thinking? You can't leave James."

"My being here won't make any difference. I'm not performing the surgery. I have a responsibility to my patient."

"What about your responsibility to your son! I can't believe you're thinking—"

Chris loudly cleared his throat. "Mart, why don't I see to your patient?"

Mentally, I frowned. Parsons wasn't a GP or a pediatrician. I wasn't even sure the last time he'd actually examined a patient. "I don't think . . ."

"I may not be you. But I am a doctor," he said pointedly. "And more than capable of examining a patient. If I have any questions, I'll call you."

I dithered. It went against everything I'd stood for as Portwenn's GP for the past decade to pass my patients to another physician when I was capable of caring for them myself. And this wasn't any patient – it was my own goddaughter and the child of my long-time receptionist.

The only people more important were Louisa and James. How could I attend to another patient while the outcome of my own son's surgery was still in doubt? James needed me and, more importantly, Louisa needed me. Even if I couldn't affect what happened, I couldn't leave them to endure the next hours alone.

"Doc?" Morwenna's voice through the phone broke my reverie. "Doc!"

I nodded at Chris and then explained to Morwenna that Dr. Parsons would be there as soon as possible. I gave him my well-stocked medical case, a synopsis of the child's medical history, and a brief tutorial on evaluating concussion in children. It would have to do.

"Mart, you focus on James," Chris told me. "I'll handle this."

As we watched Chris leave, Louisa's hand slipped into mine. I thought about James. I thought about Emma. And realized with a small sense of terror that I had no control over the outcome for either child.


	7. Chapter 7

Gratitude. The emotion a family felt toward the surgeon who had saved the life of their relative. It was the word Adrian Pitts had used more than a decade before after operating successfully on Peter Kronk. He'd asked me if I missed it – the gratitude – since I was no longer a surgeon.

At the time, I'd scoffed at his remarks. I'd always viewed surgery as a job and a successful outcome as both an expectation and the result of a job well done. Talking to the family afterward was merely one of my responsibilities as a surgeon. It gave me no pleasure. If anything, the emotions the relatives displayed – sighs of relief, tears and even the occasional fainting – were unsettling. The whole process made me uncomfortable and I'd typically made my communications with the family as brief and succinct as possible.

Years ago, Louisa and I had waited not far from where we currently sat for word on Peter. At the time, my primary concern was whether I'd done enough in the back of the ambulance to keep the boy alive. I also worried that I'd allowed my dark mood over the practical joke played on my by the locals to cloud my professional judgment. Had I followed up with Peter and diagnosed his condition earlier, there would probably have been no need for the impromptu surgery.

All that weighed on me and, when I learned that Peter would be fine, I felt an enormous sense of relief.

This evening, awaiting word on James, I felt . . . conflicted. As a GP, I knew I'd properly and promptly diagnosed my son's condition. As a surgeon, I knew the surgery was straightforward with minimal possibility for complications or an adverse outcome. As a parent, I was nervous.

My mental clock was ticking and, without looking at my watch, I knew that Pitts should be closing right about now. And Chris Parsons should be arriving at Morwenna's house within minutes. Once again, I railed at my impotence.

"He told us surgery would only take an hour," Louisa said, glancing at the wall clock across the room.

"About an hour, Louisa. Laparoscopy can sometimes take a bit longer than an open procedure."

"You're sure it's safer?"

"It has fewer complications and requires a much shorter stay in hospital."

"So you're saying it's not safer?"

I sighed. Sometimes Louisa flummoxed me. Did she really think I'd have allowed our son to undergo this surgery if there was an alternative with less risk? "The risk of complications is comparable for both procedures and is extremely low."

"Right. Good." A few seconds later, "How much longer?"

"It should be soon."

As if on cue, the waiting room door opened and Pitts – still in his surgical scrubs – strode toward us. We both stood and I felt Louisa clench my forearm.

At the site of Pitts' broad smile, the tension I'd been holding for the past hour instantly dissipated.

"The surgery went perfectly," Pitts said. "No complications at all. They're moving James to Recovery now. Give them a few minutes to get him settled and you can be there when he wakes up."

"Thank God," Louisa murmured.

I half expected Pitts to say, "No, thank me." He didn't.

Pitts had successfully completed an uncomplicated surgical procedure. It's what was expected of a surgeon of his experience. Appreciation and gratitude were unnecessary.

"When will he be released?" I asked.

"Assuming he's able to walk and eat, he should be able to go home tonight – but it will be quite late. I have to admit, if you weren't a doctor, I'd probably keep him overnight. But I'm sure you know what to watch for and what to do if there are any unexpected complications."

From any other surgeon, I would have the comment as a compliment. From Pitts, I knew it was nothing more than a statement of fact.

"Yes," I replied.

We stood awkwardly for a moment – Pitts probably waiting for the gratitude he felt was his due. And I, waiting for him to depart so I could see to my son.

"Well, I'll leave you to it then," Pitts finally said.

* * *

By the time we reached Recovery, James was already there. He looked small and fragile in the bed. The expression on his face was so peaceful that, were it not for the monitoring machines that tracked his vital signs, one might be tempted to think he was dead.

I stepped to the bed and touched the back of my hand against his forehead.

"As you can see," the Recovery nurse pointed to the monitor, "his temperature is normal."

Of course I could see it – the machines dutifully recorded it. I simply needed to touch my son, to feel him alive under my fingers.

"He should be waking up soon," the nurse continued. "When he does, he might be confused at first. It's also possible that he could be nauseous or even vomit."

Louisa looked a bit aghast.

"It's all perfectly normal," the nurse reassured her. "Nothing to worry about."

"I'm more than familiar with the potential side effects of general anesthesia in children," I informed her.

"I know you are, Dr. Ellingham," the nurse said pointedly. "I thought the information might be useful to Mrs. Ellingham."

"Yes, it is," Louisa replied, giving me a dark look. "Thank you."

"Just be reassuring when he starts to awaken," the nurse continued. "Help him orient as to time and place."

"Yes, yes," I said impatiently. "I'm sure you have other patients to attend to."

She put one hand on her hip. "James is my patient and it's my responsibility to ensure his recovery is uneventful."

Rather than respond, I pulled back the blankets and lifted James' gown. Pitts had made three incisions of about 2.5 centimeters. Each had been closed with skin glue. They were small and neat and would leave minimal scarring. From what I could see, Pitts had done an excellent job.

I yearned to review my son's medical chart. In years past, I could have simply requested it. Now that charts were electronic, getting access was a more involved process and I decided to defer it until later. Also, what I really wanted to read were Pitts' surgical notes and he was probably still in the process of dictating them.

James stirred in the bed and Louisa was instantly at his side. "James. It's Mum."

His eyes opened, he looked her, seemed to smile, then almost immediately fell back asleep.

"That's perfectly normal," the nurse said from behind us. "It usually takes a little while for children to fully come out of the anesthesia."

I checked his vital signs again, pleased to see that all were within expected values.

The nurse brought in a chair and put it beside the bed. "This'll be more comfortable, love," she said to Louisa. I noted in passing that she hadn't offered me a chair.

When James awakened again a few minutes later, he seemed a bit more alert. His gaze focused on Louisa. At first he smiled and then confusion clouded his features as he took in his surroundings.

"Where am I?"

"You're in hospital," Louisa said softly, stroking the hair on his forehead.

"Hospital?"

"You had an operation. Remember?"

"That's right, James," I added. "You did very well."

The nurse pushed forward and, after introducing herself to James, listened to his chest with her stethoscope. "Are you having any pain?" she asked when she'd finished.

James shook his head. "I'm cold."

"I'll get you some more blankets."

He turned to face me. "Dad, why am I here?"

Across the bed, Louisa looked concerned. I knew that confusion was common in post-anesthesia patients, especially children.

"You had an infection in your stomach," I said, grimacing internally at the imprecise anatomical explanation. "You had an operation to fix it which is why you're in the hospital."

"Oh."

By the time the nurse returned with the blankets, James was again asleep.

* * *

Use of mobiles was prohibited in the Recovery area and I needed to call Chris to check on Emma. I took advantage of James being asleep to make my way to the corridor outside Recovery where I could make a quick call.

Parsons answered on the second ring.

"How is she?" I asked.

"First things first," he responded. "How is James?"

"Out of surgery. In Recovery. Awake but not yet fully alert," I responded succinctly. "Now tell me about Emma."

"No signs of concussion," he reported. "Thanks goodness she was wearing a helmet."

"Are you certain?" I persisted. Did you check for blurred vision, photophobia—"

"Mart, she doesn't have concussion. She does, however, have a probable greenstick fracture of the right radius and I put seven sutures in her right calf."

"You splinted the arm?"

"Of course." Chris provided a concise summary of his treatment. Morwenna and Al would bring Emma to hospital in the morning for x-rays of the arm and a decision on whether to cast it. And he'd given Morwenna a list of symptoms to check for during the night. "She has _my_ number," he concluded. "If any issues arise overnight."

I thanked Parsons for covering for me and told him I'd follow up with Morwenna in the morning.

"Mart, focus on your son. I'll be around all night if there are any unexpected complications, and the doctors at Truro will take care of the child in the morning. As good as you are, you're not indispensible to Emma. You are to James."

Parsons was right. Yet, I was still anxious. Ever since I'd come to Portwenn, I'd hated turning my patients over to other doctors as, too often, the results had been less than satisfactory. Tonight, I had to hope that my trust in Chris Parsons was not misplaced.

I thanked Chris and headed back to my son's cubicle. As I passed the nurses' station, I wasn't surprised to find Pitts there, typing into the computer. No doubt he was entering his surgical notes. I gave him silent plaudits for doing so immediately after surgery, while his memory was still fresh. It's what surgeons were supposed to do, but too often they delayed this somewhat tedious task hours or even days.

Pitts looked up as I walked by and tried to catch my eye. "Chief, I was going to come find you. Can I have a word?"

I scowled, trying to decide whether Pitts' calling me "Chief" was his way of taunting me – in effect reminding me that I was no longer a surgeon, let alone a chief of surgery. I decided to meet his challenge head on. "I haven't been chief of surgery for more than a decade."

Pitts seemed unfazed by my correction. "Old habit," he explained without apology. "Dr. Ellingham, then," he added, motioning me toward into a nearby corner, which offered some privacy in this busy ward. I had no idea what he wanted to talk to me about. While it was possible there was something to do with James, I didn't think it likely. I'd already assessed his condition and saw no cause for worry.

"What is it Adrian?" I asked, not quite managing to keep the annoyance out of my voice.

He took a deep breath and slowly let it out. "You don't like me much, do you?"

"You performed successful surgery on my son. My liking or not liking you is irrelevant."

"I learned it from you, you know. How to treat people."

My eyebrows lifted.

"Back in London, you told us it didn't matter whether our patients or even our colleagues liked us; it only mattered that we were good surgeons."

Pitts was right. I had indeed said that to my students when I was chief of vascular surgery. Hell, I'd said as much when I came to Portwenn as the GP. And, years later, I still believed that, as a physician, being good was far more important than being liked. Dr. Sim was popular; he was also an appalling physician. Dr. Dibbs was liked; as a GP, she was an unmitigated disaster.

Patients needed their doctors to provide high quality medical care, not to be their friends. And, while it was fine to be pleasant to one's medical colleagues, the doctor or nurse you wanted assisting in surgery was the one who was the most technically competent. It was even more true in my position as chief of surgery. I had limited time to turn a bunch of green registrars into exceptional vascular surgeons. I did that by driving them, challenging them, and teaching them. I needed their respect, not their friendship.

"And I'm a damned good, surgeon" Pitts continued, interrupting my thoughts. "What's more, you know it. If you didn't think so, you'd never have let me operate on your son." Pitts' tone was matter-of-fact, stating the obvious.

I couldn't deny the truth of his words. But I had no idea where this conversation was headed. "What do you want from me?"

"I want to know why you wouldn't give me that recommendation."

Recommendation? Did he mean the one from ten years ago? When he'd wanted me to talk to Chris Parsons on his behalf? Was this about what had happened when Peter Kronk was still a child? "I don't see what—"

"I want to know. After all these years, I deserve to know. I saved your son tonight. The least you can do is tell me why, knowing I was a top-notch surgeon, you wouldn't do so much as put in a good word for me with Parsons."

Wow. So it was the issue from a decade earlier. Ten years later and it still nagged at him. I'd told Pitts at the time that he was an arse, and that Chris Parsons shared my view. It was true then – and probably still true now, though I couldn't be entirely sure. Ten years ago, Pitts had been a talented surgeon and a despicable human being. At the time, I wasn't willing to see past his personality flaws to give him the recommendation he so wanted.

Personality flaws. I recalled when I first met Louisa on the plane and then at the hotel when interviewing for the position in Portwenn. She'd certainly had reservations about my ability to function as the village GP from a personality standpoint. If truth be told, she'd probably considered me to be an "arse." What if Parsons hadn't intervened and she – and the rest of the board – had rejected me based on my personality?

At some level, I rationalized that Pitts and I weren't alike. I was widely perceived by as abrupt, dismissive or even unfriendly. On the surface, Pitts was none of those things. He appeared quite friendly – especially to those who didn't know him well. The problem with Pitts was that, beneath that exterior veneer, was a certain nastiness, even cruelty, toward others, especially when he felt aggrieved.

I recalled his comment about finding lunch for his girlfriend so she would "put out." And, not long after, he'd exposed my blood issue to the entire village. There'd been other examples such as the time when he'd been shown up on rounds and retaliated by sabotaging that colleague's research experiment.

Plainly stated, it was all about him. Adrian Pitts had disdain for those he considered beneath him. As for everyone else, he tolerated them as long as they helped him advance. He would do what it took to get ahead and, if things didn't go his way, he retaliated quickly – and viciously.

It all made sense to me. Now I had to figure how to explain it to the man at the center of it all – or whether I even wanted to.

"I told you that day why I didn't recommend you," I started. "It had nothing to do with your surgical skill and everything to do with your being an arse."

"So, I'm an arse because I tell the truth? You tell the truth and don't care what others think."

 _You tell the truth._ The same words Peter Kronk had spoken that night. I'd never shied away from telling the truth, even when it hurt. And, I wasn't so dense as not to recognize that sometimes I did hurt others, such as Peter more a decade ago. And Louisa – more times than I liked to recall.

"So tell me," Pitts persisted, "how am I any different than the great Martin Ellingham?"

Pitts' words stung. Did people view me with the disdain with which I viewed Pitts? And, if so, did I care?

Was I different than Pitts or was it merely a matter of degree in the way we treated others? Had Pitts simply taken honesty to the next level? Was Adrian Pitts simply a more strident form of me? More importantly, had I – in expressing indifference to how others reacted to my words and actions – helped create the man he was today?

No, there had to be something more, something that separated us. Louisa despised Pitts and yet she loved me enough to marry me. That had to count for something.

Pitts was staring at me, awaiting my answer.

"The difference between you and me, Adrian, is that you actually set out to hurt people. You take pleasure in it. For you, it's not about being honest, it's about being cruel."

"I don't—" Pitts stuttered.

"That's why," I continued, "I don't like you. And why, even though you're a good surgeon, I didn't recommend you."

Pitts swallowed hard. "So what you just said, that wasn't intended to be hurtful," he said, allowing the sarcasm to show through.

"It was the truth."

Pitts gave me a smarmy smile. "You know, what Mrs. Ellingham said to me all those years ago was wrong. We actually are alike, you and I."

"No, we're not," I said and turned on my heel. As I walked away, I still couldn't help but question the truth of my words.

* * *

Medical Glossary

Greenstick fracture – Occurs when a bone bends and cracks, instead of breaking completely into separate pieces. The fracture looks similar to what happens when you try to break a small, "green" branch on a tree. It is common in young children.


	8. Chapter 8

"How's Emma?" Louisa asked when I returned to James' cubicle.

"She's alright." I rubbed my face as the strains of the day started to catch up with me. "Probably a fractured radius. Morwenna will bring her to hospital for x-rays in the morning."

"Oh, no."

"Could have been much worse," I replied somewhat automatically, focusing my attention on my son, who was once again awake. The nurse was busy checking James' vital signs, assessing level of consciousness, and examining his incision.

"James, how are you feeling?" I asked.

"Better," he replied, with an expression somewhere between a smile and a grimace.

"Are you having pain?"

"I already asked him that," the nurse interrupted, giving me an annoyed look. "I do know my job."

I ignored her. "James?"

"I'm okay, Dad."

"Good. Be sure to let me know if you have any pain, any pain at all."

This cycle of waking and falling asleep repeated itself several times before James was fully awake. During that time, both the anesthesiologist and the surgical registrar came by. The anesthesiologist seemed pleased that James wasn't nauseous.

"I assume you used anti-emetic prophylaxis," I said.

"Yes. Ondansetron. I've found it to be quite effective in pediatric patients."

The registrar's examination was brief and largely consisted of checking the wound followed by a brief physical exam. If he was nervous with my hovering over him, he didn't show it.

"How is the bowel function?" I asked.

"Working fine. In fact, everything looks good. Are you hungry, James?"

James shook his head. "Not really."

The registrar smiled. "Would you like to go home tonight?"

This time James nodded eagerly.

"Well, before you can do that, I need you to do two things for me. First, you need to walk to the loo and relieve yourself. Second, you to eat something. Just a little. Do you think you can do that?"

"Right now?"

The registrar laughed. "No, not right now. When you're ready. How's that sound?"

"Okay, I guess."

The registrar took me aside, his tone a bit more serious. "You know the drill, Dr. Ellingham. If your son's comfortable walking and urinating and eating tonight, I'll send him home. It's late, so if he's not ready for that, we'll keep him overnight and send him home first thing in the morning. The nurses will keep me informed."

Over the next few hours, James slowly returned to his "old self." He became more alert and animated. He got out of bed and walked to the lavatory. And, finally, as the summer sun finally set, he managed to eat some crackers and applesauce and keep them down.

The process to get him released from hospital took longer than, in my view, it should have. Another visit from the registrar. Taking out his IV line. Having him change back into his clothes. And, finally, the seemingly endless list of post-operative instructions.

No bath for 48 hours. Shower okay after 24. No strenuous activity for at least a week. Call immediately if there is high fever, the wound edges open, there is redness or sign of infection. And on and on.

Obviously, I was well versed on everything. The only reason I didn't interrupt is that I knew the hospital was legally required to go over each item with the patient and his family, even if that family included a GP and former surgeon. So, I did my best to tolerate the drivel and the delay. Louisa listened attentively while making sure we had all of James' clothes and belongings.

* * *

As the three of us slowly walked out of the hospital, I once again marveled at the advances of modern medicine. A century ago, James would certainly have died. Two decades ago, he would have been in hospital for at least several days. Now, he went from being carried into the hospital with a life-threatening condition to walking out on his own in less than ten hours.

We sat in the back of the taxi headed back to Portwenn, just as we had a decade ago after Peter Kronk's surgery. The difference this time was that James was sandwiched between us, once again asleep.

"Is he alright?" Louisa asked, nodding at him. "It seems odd to be taking him home so soon after surgery."

I touched the back of my hand to his forehead. "He's sleeping normally." I'd already checked his pulse and respirations. "Laparoscopic appendectomy is typically same day surgery. I wouldn't have taken him home if I didn't think he was ready."

"Right."

The last time we'd done this, Louisa had rushed back into the hospital while I waited in the taxi. At the time, I'd thought she'd forgotten something. I now knew that she's used the time to confront Adrian Pitts. He'd insisted that whatever she'd said wasn't true. Now, I was curious as to what had transpired so long ago.

"Louisa, what did you say to Pitts that day when Peter Kronk had the surgery, when you went back into the hospital?"

She sighed. "It was a long time ago, Martin. It's not important now."

"Yes it is. To me, that is."

Louisa took a deep breath.

I was suddenly concerned. "He didn't threaten you, did he?"

"Threaten me?" she scoffed. "He wanted to go out with me."

I was suddenly angry, even though I shouldn't have been. At that time, Louisa and I weren't lovers. In fact, that day before the ride in the ambulance, we were barely even speaking to each other. The source of my consternation was my certainty that Pitts had ulterior motives for his request.

"I thanked him for saving Peter's life," Louisa continued. "He must have thought that I was interested in him or something like that."

Pitts probably thought every woman was interested in him, I thought, but remained quiet, anxious to hear the rest of the story.

"Then I told him that you were ten times the man he'd ever be."

My eyebrows went up at that.

"And that, if he ever did anything again to hurt you, I'd be the last person he'd ever want to see." Her voice was strong and confident. I could picture her saying those words to Pitts that day. And wished I'd been there to see the expression on his face when she did.

"Why didn't you tell me?"

She shrugged. "Dunno."

After the nasty things I'd said to her and to Peter that day, I was the one who probably deserved the verbal tongue-lashing. Instead, for some inexplicable reason, Louisa had stood up for me. Even more, she'd gone back into the hospital, sought out Pitts, and given him a piece of her mind. What had I done to deserve that?

"Why?" I asked.

"Why what?"

"Why did you go back and say those things to Pitts?"

"Because, Martin, you're a excellent doctor and a good man. You were then and you are now. And scum like Adrian Pitts needed to know that's what people think of you. Well, at least one person."

Her words filled me with a swirl of emotions – pride and love and admiration. And made me feel even worse that on the way home that day, rather than giving her the kiss she so deserved, I'd instead focused on her halitosis.

"What did I ever do to deserve you?"

"Martin?"

"Pitts was right. I am just like him."

"What?"

"Today, Pitts said that I'm just like him."

"No, you're not. You're nothing like him. Martin Ellingham, you are the kindest, most caring doctor, husband and father that I know. Of course, you can be bit brusque at times. And maybe not always as tactful as you might be. And I suppose there are some who think—"

"Louisa!"

I reached across our sleeping son and took her chin in my hand and pulled her close. This time, I made sure the ending to our conversation was exactly what it should be – and what she deserved.

* * *

Medical Glossary and Author's Notes

Anti-emetic prophylaxis – drug(s) given prior to surgery to minimize the likelihood of post-surgery nausea and vomiting

Well, my little tale has come to an end. I hope you've enjoyed the ride. I again want to thank each and every one of you who has taken the time to post a comment/review. Those of us who write fanfic do it first and foremost because we love continuing and expanding our favorite show. That said, it's always terrific to know that our readers enjoy and appreciate our efforts.

Finally, another shout-out to my great beta JD517, who provides wisdom and encouragement - and always makes my stories better.


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